I have realized that the therapist I chose from my insurance plan's list of clinicians is a behavioral therapist. I don't know how I missed that when i was looking for someone, but I did. CBT is not for me and I have tried it several times before. I knew that I specifically did not want that. Yet, there it is in her profile.

Now I feel like an idiot. I wanted psychoanalytic psychotherapy. When she said she did psychodynamic psychotherapy, I misunderstood.

No wonder I am frustrated that she doesn't want to talk much! I am trying to make it into something it isn't and never will be.

So, realizing this I began a new search through the clinician directory of in-network providers. Most listed CBT in their profile. The ones that didn't I called an they said they do CBT or are 'solution-focused' (same thing). So I called the insurance company and asked if ALL their clinicians are Behavioral therapists. Yes, the supervisor told me. He went on, Research does not show that long term therapy is more helpful than short term therapy. I tried to tell him I was not looking to establish a length of treatment timeframe, but wanted a particular therapy model/orientation. And, that they had sent me (insolicited) literature that indicated that for some diagnoses long-term therapy was needed. Bottom line is that my insurance company has the power to limit my choices for treatment and that makes me so angry.

To find what I want I will have to pay for it myself. I don't know if I can to be honest.

But I want what I want. I don't want to learn new tricks, or to salivate at the sound of a bell, or to have positive suggestions made while in hypnosis. I want to understand why I have the perceptions I have, where they came from how they work (or don't). There is so much to learn.

I am so frustrated and deflated I thought I had found what I wanted and needed. I truly like this psychologist and I trust her. But we are not on the same page and will never be because I want something other than what she offers.

Sigh.. I need hugs. I feel so alone again.

ECHOES

((( HUGS )))

[sunrise]

</font><blockquote><div id="quote"><font class="small">Quote:</font>
ECHOES said:
Now I feel like an idiot. I wanted psychoanalytic psychotherapy. When she said she did psychodynamic psychotherapy, I misunderstood.

</div></font></blockquote><font class="post">ECHOES, hold your horses. I think you're OK!

"Psychodynamic psychotherapy" is the modern version of psychoanalytic psychotherapy. It involves transference, looking into your past, the whole shebang. In contrast to classic Freudian psychoanalysis, however, it is usually shorter term, does not necessarily meet several times a week, the client sits rather than lies down, and the therapist is usually seated facing the client, rather than the analyst being hidden from view behind the client as the client lies on a couch. But other than that, there are a number of similarities. Your therapist may list that she has several influences and orientations on her description. This is called an "eclectic" approach. Ask her if she can emphasize the psychodynamic approach in her plan with you, rather than CBT, since apparently she is versed in both (good for her!).

My therapist is also eclectic. He is humanist/psychodynamic/gestalt and has been known to sneak in a little CBT here and there. Plus, he does EMDR. It's the best of all those worlds in the MIX that works for me.

Good luck,
sunny

Hi sunrise,

But based on my experiences with her and what I'm reading it seems like "therapy lite". Even though she said we'd get to what my mom did to me, via hypnosis, she doesn't seem to want to hear what I'm feeling or experiencing currently. And once when I said I thought something came from my past she said that not everything in the past is negative and that she likes to focus on here and the future.

I don't now how to sort this out.

ECHOES

[sunrise]

</font><blockquote><div id="quote"><font class="small">Quote:</font>
Bottom line is that my insurance company has the power to limit my choices for treatment and that makes me so angry.

</div></font></blockquote><font class="post">Yep, that's where I'm at too. My insurance will not reimburse for my T (but it's due to his academic degree, not his therapy orientation). It can be so frustrating when they refuse to pay! What am I paying those monthly premiums for?

</font><blockquote><div id="quote"><font class="small">Quote:</font>
I truly like this psychologist and I trust her.

</div></font></blockquote><font class="post">That is so important. Just ask her if she can emphasize the psychodynamic rather than the CBT. Maybe not completely throw out the CBT, just shift the emphasis a bit. (ETA: Sorry, our posts crossed and I see you answered this in your post above.)

(((hugs)))

[sunrise]

</font><blockquote><div id="quote"><font class="small">Quote:</font>
ECHOES said:
Even though she said we'd get to what my mom did to me, via hypnosis, she doesn't seem to want to hear what I'm feeling or experiencing currently.

</div></font></blockquote><font class="post">I wonder why she is so willing to deal with your past through hypnosis but not through your conscious mind? That seems odd to me.

I can see why you are confused. Hang in there. ((((hugs))))

sunny

i think because i haven't been able to talk about it.. or maybe she is making sure I have coping skills before we get there.

Here is an article that i read on psychoanalytic therapy:

http://www.psychjourney.com/Thoughts...c%20Theory.htm

and another site where i've been reading:
http://www.guidetopsychology.com

thanks for posting. I don't know if I can hang in or not.

ECHOES

hey there. i'll admit i don't really know very much about precisely what your therapist is doing with you in your therapy sessions (e.g., whether it is considered to be some kind of 'systematic desensitisation' or 'visualisation for relaxation' or quite what) but... i've expressed my concerns about the hypnosis already. i'm sorry i went on about that before... there were some good posts after mine and i'm glad other people were able to jump on in and be more helpful than me (i really do miss the mark sometimes).

it is making more sense to me now... that she is using the techniques so that you get to talking about the trauma *quickly* though (i.e., so that treatment is fast which the insurance companies like). i'm wary about using hypnosis to facilitate that (for different reasons than the reasons i was concerned about hypnosis before). basically... i think it can be more profitable to learn to trust appropriately so that generalises back to real life rather than being 'conned' into trusing via some technique that doesn't really have an 'outside therapy' analogue that is likely to profit you any...

anyhoo... back to the insurance provider situation...

you are right that there is 'brief psychodynamic therapy' which is comperable to 'cognitive behavioural therapy' with respect to time frame. individual therapists can be more or less wedded to one particular theoretical orientation (such as CBT) and more or less competent in / willing to try some techniques and strategies from other (e.g., psychodynamic or humanistic / existential) types of approaches. i know a few people who have trained in CBT but who personally find CBT to be of limited usefulness. It was just that that is what they learned to do in their training and their supervisors were fairly hostile to alternative approaches. They have read up on alternative approaches and attended seminars, conferences, and workshops etc, however. They say that they enjoy the opportunity to practice more from that orientation with clients who are willing.

Listing 'CBT' as a theoretical orientation is a big winner for the insurance companies. The insurance companies listing you as a provider who they will reimburse is a big winner for your private practice. That isn't to say that the therapists on the list 'prefer' CBT but it is to say that your insurance provider does. If I were you... I would try the list again (even those who claim they are CBT therapists) and I'd say that you have done CBT and haven't had much success with that for trauma related issues and you are keen to try something more psychodynamic. Are they willing / able to do something like that or not?

Certainly worth a shot.

[Talulah]

Oh man echoes, are we ever in the same boat together!
((((((((((HUGS)))))))))))
I hope I did that right, those are hugs up there.

I asked my t just the other day what orientation she is because i was getting confused (you read my other post). She told me "systemic" but that it's a very eclectic approach with psychdynamic/CBT, but like yours, I feel like we just don't go that far into the emotion behind the events in younger life.

So, I don't know, I'm with you, I can't decide where or what to do. I absolutely adore my t. I even told her this dilemma and she asked if I liked her, I said yes, she said something to the effect that she'd rather me have this problem with her, being someone I like (as to mirror more my real-life experiences) than go to a t and begin again, as she believes this is a trust issue. Also, she urged me to trust her and said she wants to get all my symptoms under control before we go with the hard stuff because it would undermine my ability to deal with the outcome. So, whatever, I see her point but it's like we think we're ready and they think otherwise. I may lose my nerve.

Maybe yours is trying to get some behavioral techniques down before dealing with the past. Bring it up again, see what happens and then mull it over and you'll do what's right.

As far as the insurance Bulls**t, they got us all by the cojones. My t puts down "relationship problems" as my code and even gave me the number. So I don't know what these docs do. My relationship is about the only thing going good for me.

I really want you to tell me how this works out for you, and I'll do the same.

[pegasus]

Hugs ((((((((((((( Echoes )))))))))))))))

I can't comment on the insurance situation because I'm not from round your way.

But as far as therapy goes- imo, psychoanalytical therapy is seriously heavy stuff and you have got to have done the easier stuff before getting to that level of therapy.

Also imo most practicing psychologists are eclectic in their approach these days, and you won't know what type of therapy he/she is doing with you all the time unless you are asking for a running commentary through-out the session.

I would be inclined to stick with your T beings as you have the trust there, and start to discuss with her what it is that you wish to gain out of therapy.

Take care.

[(JD)]

</font><blockquote><div id="quote"><font class="small">Quote:</font>
No wonder I am frustrated that she doesn't want to talk much

</div></font></blockquote><font class="post">

Most T's do more listening than talking...and analysis therapy is usually allowing the patient to do all the talking for years until it dawns on them ...whatever is supposed to dawn on them. If you're not happy with an interactive CBT clinician, how can you want analysis? Sorry, I'm confused.

</font><blockquote><div id="quote"><font class="small">Quote:</font>
But I want what I want.

</div></font></blockquote><font class="post"> Ok, that's fair. Help me out here, what do you really want? You stated some things that you don't want (and I don't blame you on those, but somehow you seem to think those are CBT??? )

Keep talking!

[sunrise]

</font><blockquote><div id="quote"><font class="small">Quote:</font>
No wonder I am frustrated that she doesn't want to talk much

</div></font></blockquote><font class="post">Sky, I took this to mean that ECHOES' therapist doesn't want to have much talking going on in the sessions, because ECHOES has posted before that she wants to talk more in her sessions, but the T wants to do guided imagery and hypnosis and not let ECHOES talk about her problems. Is that right ECHOES, you want to have more of a talk therapy but T does not?

That said, ECHOES, I too am confused about what you posted that suggested CBT-oriented T's would not want to have talking in the sessions? A lot of them actually emphasize that way of interacting. You go for an hour, talk about your issues and try to change your thinking about them to promote change. I had a CBT counselor for a while, and all we did was talk--mostly me, but she asked questions along the way or would give specific advice based on her expertise if I requested it.

sunny

Thanks sunny, yes you are right in what you said about my wanting to talk but the T not encouraging it. I tell her something, as I've tried to tell her about my 'falling apart' that I wrote about in my "chicken letter to my t" post and I get a reaction comparable to "huh". End of discussion. In the midst of working on expressing my thoughts and concerns to her last session about wanting to talk more and other questioning what we are doing she replied that she uses the approach that suits the person she is working with. I thought we were in a discussion but at the end of her statement she asked what I wanted to work on. I WAS working on... on voicing my concerns which is so hard for me.

Every session I am to say what I want to work on. Meaning, it will be the focus of the guided imagery. For example I chose to work on self-criticism. Since that is a negative, we turned it into a positive goal of working on awareness and objectivity. All done via the guided imagery.

She knows I have been talking informally with a person who has a doctorate in psychology but doesn't practice (developed a separate successful business during school and training and decided to stay with that) and who is analytical. I have told her that I like that. Just last session when I told her I'd been talking to the other person (who this t talked with before I began with her) and that I really liked it, this t pointed out the the other person was analytical as if comparing the two of them and telling me that she is not.

If I tell her, as I did last session, that I had an episode of 'falling apart' (emotional meltdown) again and that I was still reeling from it, I want her to want to know more about it. I want her to ask me what it's like when that happens. How it starts, what happens next, what I'm feeling, how it runs its course, etc.

She is convinced that all the things we do (behavior) is the result of the unconcious telling us to do the same thing we've always done, in spite of learning or knowing other things conciously. For example, a person knows it is not a good thing to smoke, they want to quit, they have many good reasons to quit; so they quit, but are drawn back to it by the unconcious. (In my defense here, I quit cold turkey on my own on 3/1/05 and in spite of many extremely stressful times I have not gone back to it, so I have some skepticism there when she says that and uses that example)

When I want to stay inside all the time, I want to talk about why I want that. What thought processes are involved in deciding it is better to stay inside, what thoughts are there that I am scaring myself with when I think about going out. When I have frequent panic episodes about being alone and feeling incapable of caring for myself and fears of losing what little I haven't yet lost, I want to talk about it and I want some reassurance. I want to feel that she cares about me and will take care of me, or help me take care of me.

I can follow instructions. I can read a map. But I want to do more than move from point A to point B just because that is the path that has been decided I need to take. I want to understand point A and be part of the decision as to where and what point B is.

I have unresolved childhood abuse issues. I have unresolved adult abuse issues. I just finished raising my son alone, last year insisting (with help from police because of his anger/threats) that he live independently (he was 27). I moved across the country 4 years ago then lost my car and became a bus person. In a 10 year time prior to that I lost a beloved job of 12 years to downsizing of the entire office (and subsequently was downsized 3 more times), lost my house in a wonderful neighborhood, put my son through drug rehab, lost both my parents. Just the way it goes and others have faced much worse than I have. So now, I'm finding it hard to deal with the past that won't leave me alone and I don't know where I want to go from here...move on to ??? I just want to feel better, not be afraid all the time, not have emotional meltdowns, not stay isolated. I don't know who I am anymore.

Of all that, my t only knows about that I have unresolved abuse stuff. She has talked in generalities about distancing oneself from things in the past so they don't feel like they are happening again now. That the unconsious is what keeps the connection and creates the fight or flight responses to it. I trust that she is right on this. But there is just something lacking for me. What about right now? What about my meltdowns? What about me, my feelings, my fears? Helping me understand where the depression and anxiety come from?

Well I didn't mean to ramble, I just sat down and wrote. I don't know if that helps explain it any more or not. I'm not coming from the same place as I was a few days ago if you know what I mean? Some days I feel thoughful and articulate and other days I have a very hard time expressing my thoughts and feelings. This is a time of mental confusion and slowness for me. Bear with..thanks.

ECHOES

hey. i can't really figure your t...

she doesn't sound like a behaviourist to me (with the focus on hypnosis)
she doesn't sound like a cognitive-behaviour therapist (with her unwillingness to problem solve)
she doesn't sound analytical / dynamic
she doesn't sound humanist...

i think she thinks she is 'being eclectic'.

but...

maybe it isn't the most helpful thing for you.

could you take your last post...

and print it out...

and take it along...

and say 'what i want to talk on today is whether we are suited to continue working together'.

you are entitled to have a clear view of what she thinks will help you... and you are entitled to say 'no, actually, that is not to my tastes'.

like when you go to a hairdresser and you tell them what you want (ie i want to be able to run my fingers through it and rush out the door and for it to look respectable AND i want to be able to take some time with it so it looks nice when i go out). they can say 'here is what i would like to do' and there is a certain amount of haggling that can be had...

but there comes a point when you change salons.

if she isn't willing to talk to you about this stuff...

well...

your post was great because you talked about what you wanted to talk about in therapy and you also said how 'ideally' she would respond / react to your self disclosures.

i guess it is up to her whether this is a strategy she feels competent in or not...

[January]

(((((((((( Echoes )))))))))))))

I care.

Hugs,

Jan

I love you all for listening to me. Thanks so much.

ECHOEs

[sunrise]

Echoes, you seem really together to me. You have some good ideas about what will help you and the issues you would like to work on. All you want is to talk to your T and have her listen and talk too, for gosh sake!

I hope I am not going to step on toes here, but I think your T is fixated on Guided Imagery and Hypnosis as a cure-all for every client. Your wanting to do talk therapy is such a benign request. Almost all T's do talk therapy of some form. It must feel so frustrating to want to talk about your issues with your T, work on solving your problems, and have her only want to do Guided Imagery. It would seem like such a rejection to me, like she was trying to fit a square peg into a round hole. Maybe you could just lay down the law and tell her you really like her and all, but you don't want to do anymore Guided Imagery/Hypnosis. Can she handle that? Or is she a one-trick pony?

(((hugs)))
sunny

Thank you Sunny, I am not at all really together but I read and research a lot and have had a wonderful year with the person online I referred to who has a doctorate in psychology. The gap between intellectually understanding things and feeling them is what I'm trying to fill.

I want to explore and understand the perceptions and thought processes that are connected to my problems. She wants to work on tasks like acquiring assertivenes, for example. That is CBT to me: solving without exploration and understanding. Task-oriented instead of process-oriented. For example, I want to explore abandonment, worthlessness, lovability, control, separateness, intimacy. Where were they learned? What are my perceptions? How do they work in my life? How do they work in helpful and in unhelpful ways....

The difference to me is that CBT tells me what to do but it doesn't change anything internally. I can 'do' a lot of things but I still feel empty and alone and afraid; depressed and anxious.

I like the guided imagery. I like that she's introduced me to that and indirectly to meditation and relaxation. The meditation and relaxation would be more helpful if I could have more calm days that I'm not spending all my energy on trying to hold myself together. I don't know how helpful the guided imagery has been but it is enjoyable to do. I want to add to it is all. Maybe I want too much.

ECHOES

Sky, I wish I could explain it better.

I happened upon a post by Dr Clay this morning and this explains so well what I want. I don't know how to do the quote box, so I copied and pasted his paragraph in its entirety and am bolding the part that explains what I want.

"My wife went to see the movie, Freedom Writers, last weekend. I thought it was good. It documented the good that can come from freely expressing your feelings (and the causes of those feelings) to people who will listen with concern to your situation and your sorrow. The students were certainly in emotionally frustrating situations--they hated each other; they hated their violent situations; they had a lot of needs that were not being met and they had little hope their dreams would ever come true."

ECHOES

[DavidStrong]

Sounds like you're looking for something Carl Roger-esque to me. But your insurance company is right, meta-analysis does show that outcomes are similar no matter the orientation. However, what is more important than anything else, and it appears that you have this, is trust in the person and the process.

I have similar issues with the psychologist that I go to. She operates differently than I expected. This makes it difficult for me a lot of the time. I just try and tell myself to go with the flow and what needs to come out will, in time.

i don't have trust in the process. that's what this is all about really.

thanks for your reply and good luck to you.

i guess you have two options:

to accept things as they are
to try and change them

with respect to change that can be broken down into:

try and change her (i.e., try and tell her what you want)
try and change you (i.e., try and go with what she is doing)
leave her and find someone whos thinking on these things is the same as you

probably there are other options but... haven't had coffee yet ;-)

it doesn't sound like what you are wanting is unreasonable to me. as i said i would have been out of there a while ago. only... you know maybe i wouldn't have been because the guided imagery stuff does sound kinda cool. but yeah, i'm a process person myself as well...

[Talulah]

Yeah, I think you are articulating perfectly what your desires are. And, it sounds like you do want an eclectic blend. I agree with alexandra, print that post (and the one after you wrote) out and take it in and make it a point to say, let's see if we can reach this together...

I think I sense you wanted what I want also,someone to really care about what happened to me. I want them to care so much they cry with me, ask me questions about it and go down that dark path with me. But, i don't know how to do it, so i want a guide. I'm asking for a stranger guide to lead me into my unknown self-weird, But I guess this is what I want.

I feel you when you say that she doesn't ask questions. Maybe shes afraid to push and she's wanting you to take the lead, but for some of us I think that can be difficult. I need to be babied a bit whereas others here are much more assertive and confident than I, they are wiser.

Go in with your desires, both known and unknown. The fact is, you've reached a point where you're not sure if she can help you, it sounds like it's something she should hear. She probably would welcome the feedback.

Oh Echoes!!!!!! I feel very sorry for the many tragedies you've endured. Too many losses, I am sending you positive vibes and as much goodness as I can find! I am across the US from you, but you have made my heart ache and I am so glad you are here. Keep going.

my word for the day/week/month/year:

attunement

i've been reading Schore and I am %#@&#! BLOWN AWAY
OMG!!!!!
i cried and cried and cried and cried

attunement

i don't think you are asking too much echoes
i realy really really really really really don't
so i guess the million dollar question is:
will your therapist provide it for you
OR
will you have to thank her very much for all she has helped you with and...
find someone who is prepared to offer you what you have identified with needing?
personally...
i really don't think you are asking too much
((((((((((echoes))))))))))

Well I give up.

She cancelled on me the last 2 weeks.

I got the usual call on Thursday from the receptionist, confirming my 1:00 appt on Friday. Then she called Friday morning saying the doctor is out sick...again.

Is she sick or allergic to Fridays? (3 times in 10 weeks).
I don't know. But I have to think of if this suits me; is she reliable enough for my needs...

I tend to fall apart easily over things like this and I'm trying to not let that happen. I just don't know what to do.

ECHOES